磁共振质子密度脂肪分数(MRI-PDFF)评估慢性HBV感染者肝脂肪变性及分布特点  

Value of magnetic resonance imaging-proton density fat fraction in evaluating the degree and distribution characteristics of hepatic steatosis in patients with chronic hepatitis B virus infection

作　　者：王丽旻 包超[2] 赵凯越 靳婕华 郑卓肇[2] 黄缘[1] WANG Limin;BAO Chao;ZHAO Kaiyue;JIN Jiehua;ZHENG Zhuozhao;HUANG Yuan(Department of Gastroenterology,Beijing Tsinghua Changgung Hospital,Tsinghua University,Beijing 102218,China;Department of Radiological Diagnosis,Beijing Tsinghua Changgung Hospital,Tsinghua University,Beijing 102218,China)

机构地区：[1]清华大学附属北京清华长庚医院消化内科,北京102218 [2]清华大学附属北京清华长庚医院放射诊断科,北京102218

出　　处：《临床肝胆病杂志》2024年第5期934-939,共6页Journal of Clinical Hepatology

基　　金：北京市自然科学基金(7202240);清华大学自主科研项目(2022PY002)。

摘　　要：目的利用磁共振质子密度脂肪分数(MRI-PDFF)评估慢性HBV感染者的肝脂肪变性的程度。方法选择北京清华长庚医院2018年1月—2022年12月门诊或者住院,明确诊断为慢性HBV感染,年龄>16岁的患者。所有患者均在本院行肝脏磁共振检查。依据是否合并肝硬化进行分组,比较患者的各个肝段PDFF值的一致性。使用Kappa一致性检验、组内相关系数(ICC)进行一致性分析。结果纳入76例核苷(酸)类似物经治患者,其中30.26%(23例)合并肝硬化,所有患者的MRI-PDFF算术均值波动在1.49%~30.93%,依据MRI-PDFF≥5%诊断为脂肪肝,38.16%(29例)患者合并脂肪肝。76例患者的全肝PDFF算术均值低于全肝PDFF加权均值,全肝PDFF加权均值、全肝PDFF算术均值、左半肝及右半肝的PDFF算术均值比较,差异无统计学意义(F=0.39,P=0.76)。各个肝段、左/右半肝PDFF算术均值与全肝PDFF加权均值、全肝PDFF算术均值的一致性较强(ICC均>0.75),但右半肝PDFF算术均值与全肝PDFF加权均值的一致性高于左半肝。合并肝硬化组患者在区分脂肪肝诊断的一致性检验方面,Ⅶ段PDFF算术均值与全肝PDFF加权均值一致性差(Kappa=0.39),左半肝、Ⅰ、Ⅱ、Ⅲ、Ⅴ、Ⅵ、Ⅷ为中等一致。合并肝硬化的患者Ⅶ段PDFF算术均值与全肝PDFF加权均值一致性最低,Ⅳ段一致性最高。未合并肝硬化的患者Ⅱ段PDFF算术均值与全肝PDFF加权均值一致性最低,Ⅴ段的一致性最高。结论MRI-PDFF评估慢性HBV感染者的肝脂肪变性更全面,合并肝硬化的患者各肝段PDFF算术均值与全肝PDFF加权均值的一致性差异大。Objective To investigate the value of magnetic resonance imaging-proton density fat fraction(MRI-PDFF)in evaluating hepatic steatosis in patients with chronic hepatitis B virus(HBV)infection.Methods The patients,aged>16 years,who visited the outpatient service or were hospitalized in Beijing Tsinghua Changgung Hospital from January 2018 to December 2022 and were diagnosed with chronic HBV infection were enrolled,and all patients underwent MRI examination of the liver in our hospital.The patients were divided into groups based on the presence or absence of liver cirrhosis,and the consistency in PDFF between different hepatic segments was compared between groups.The Kappa consistency test and intraclass correlation coefficient(ICC)were used for consistency analysis.Results A total of 76 patients treated with nucleoside analogues were enrolled,among whom 23(30.26%)had liver cirrhosis.For all patients,the simple arithmetic average of PDFF fluctuated between 1.49%and 30.93%.According to MRI-PDFF≥5%as the diagnostic criterion for fatty liver disease,there were 29 patients(38.16%)with fatty liver disease among all patients.For all 76 patients,the simple arithmetic average of PDFF was lower than the weighted average of PDFF for the whole liver,and there was no significant difference between the simple arithmetic average of PDFF,the weighted average of PDFF,and the PDFF values of the left and right lobes of the liver(F=0.39,P=0.76).The consistency test showed that the PDFF values of each hepatic segment and the left and right lobes of the liver had strong consistency with the weighted average and simple arithmetic average of PDFF,with an ICC of>0.75,but the consistency between the PDFF value of the right lobe and the weighted average of PDFF was higher than that between the PDFF value of the left lobe and the weighted average of PDFF.In the consistency test of differentiating fatty liver disease in patients with liver cirrhosis,there was poor consistency between the PDFF value of segmentⅦand the weighted average of PD

关 键 词：乙型肝炎病毒 脂肪肝 磁共振成像 

分 类 号：R575.5[医药卫生—消化系统] R512.62[医药卫生—内科学]